Pros and Cons of Permanent Brachytherapy

Pros

• Provides a high tumour dose which has a high chance of eradicating all of the cancer
• Has the same survival rate as other radical treatments (such as surgery, external beam radiotherapy)
• Minimises dose to local normal tissues. This is because the radiation dose conforms to the shape of the individual mans prostate and the dose of radiation drops very quickly away from the seeds
• Has fewer long-term side effects than other radical treatments - less impotence (30-50% risk) than surgery and less bowel side effects than external beam radiotherapy
• Is minimally invasive and a "procedure" not "surgery"
• Is a one off treatment procedure with usually an overnight stay only
• Provides early return to usual activities.

Cons

• Urinary symptoms such as reduced flow, frequency, urgency and stinging are common after the implant and for at least several months and occasionally a year or longer
• Like all treatments there is a small risk of more serious side effects
• High cost - for radioactive seeds, complex planning, and need for multidisciplinary team for implantation
• There are some minor radiation safety precautions required
• " It is a "high tech" treatment and outcome is related to the expertise of the treating team.

Follow up

Patients are scheduled for a CT scan of the prostate about one month after the treatment to assess the position of the radioactive seeds in and adjacent to the prostate. This is a vital part of our quality assurance without which we can not determine that the dose and coverage of the implant has been adequate.

Ongoing follow up involves clinical assessment including digital rectal examination (DRE) and PSA blood tests. These will involve your referring doctors and General Practitioner . The frequency of these follow up visits reduces over time.

It can take several years or longer for the PSA to drop to its low point (nadir) and there may be some temporary "bounces" or "spikes" in PSA not due to cancer especially in the first 2 years. Most men's PSA eventually drops to <0.4 by 5 to 6 years after brachytherapy.